Ekström A M, Serafini M, Nyrén O, Hansson L E, Ye W, Wolk A
Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Int J Cancer. 2000 Jul 1;87(1):133-40.
In spite of diverging incidence trends, subsite, and subtype-specific gastric cancer data on the association with dietary antioxidants are sparse. We aimed to test whether the apparent protective effect of antioxidants is mainly confined to noncardia (distal) cancer of the intestinal subtype, to which most of the incidence decline in gastric cancer has been ascribed. In a Swedish study base (total population 1.3 million), we interviewed 567 cases uniformly classified to subsite (cardia vs. noncardia) and subtype (intestinal vs. diffuse), and 1165 population-based controls, frequency matched for age and sex. Serologic data on H. pylori status was available for a subset of 542 individuals. Ascorbic acid (vitamin C) was inversely associated with all subsites and subtypes of gastric cancer in a significant dose-response manner (all p<0.05), with risk reductions between 40% and 60%. beta-carotene was also strongly and negatively associated with risk, particularly with the intestinal type. The associations with alpha-tocopherol (vitamin E) were less clear. The highest parallel intake of all three antioxidants (quartiles 4), compared to those with the lowest parallel intakes (quartiles 1), was associated with a 70% lower risk of developing noncardia cancer (OR 0.3, 95% CI 0.1-0.9). Our results suggest that antioxidants might be especially beneficial among subjects at increased risk for gastric cancer such as smokers and those infected by H. pylori. We conclude that a high intake of antioxidants, as a consequence of high consumption of fruit and vegetables, may lower the risk not only for gastric cancer of the intestinal type, but also for diffuse type adenocarcinoma and cardia cancer.
尽管胃癌发病率趋势、亚部位及亚型特异性数据有所不同，但关于饮食抗氧化剂与胃癌关联的数据却很稀少。我们旨在检验抗氧化剂的明显保护作用是否主要局限于肠型非贲门（远端）癌，胃癌发病率下降大多归因于此。在瑞典一个研究数据库（总人口130万）中，我们访谈了567例按亚部位（贲门与非贲门）和亚型（肠型与弥漫型）统一分类的病例，以及1165名按年龄和性别频率匹配的人群对照。542名个体的子集有幽门螺杆菌感染状态的血清学数据。抗坏血酸（维生素C）与胃癌所有亚部位和亚型呈显著剂量反应关系的负相关（所有p<0.05），风险降低40%至60%。β-胡萝卜素也与风险呈强烈负相关，尤其是与肠型。与α-生育酚（维生素E）的关联不太明确。与所有三种抗氧化剂平行摄入量最高（四分位数4）的人群相比，平行摄入量最低（四分位数1）的人群患非贲门癌的风险降低70%（OR 0.3，95%CI 0.1 - 0.9）。我们的结果表明，抗氧化剂可能对胃癌风险增加的人群（如吸烟者和幽门螺杆菌感染者）特别有益。我们得出结论，由于水果和蔬菜摄入量高而导致的抗氧化剂高摄入，可能不仅降低肠型胃癌的风险，还降低弥漫型腺癌和贲门癌的风险。
